1
|
Yuan G, Nguyen TN, Liu L, Li R, Xia H, Long C, Wu J, Xu J, Huang F, He B, Wu D, Wang H, Feng C, Liang Y, Zhou X, Xiao Z, Luo L, Hu Y, Liu B, Peng W, Zhang C, Cui T, Zhao G, Xu L, Ma G, Hu W. Effect of Stroke Etiology on Endovascular Treatment for Acute Basilar-Artery Occlusion: A Post Hoc Analysis of the ATTENTION Randomized Trial. Stroke 2024; 55:1973-1981. [PMID: 39038096 DOI: 10.1161/strokeaha.124.047568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Stroke etiology could influence the outcomes in patients with basilar-artery occlusion (BAO). This study aimed to evaluate the differences in efficacy and safety of best medical treatment (BMT) plus endovascular treatment (EVT) versus BMT alone in acute BAO across different stroke etiologies. METHODS The study was a post hoc analysis of the ATTENTION trial (Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion), which was a multicenter, randomized trial at 36 centers in China from February 2021 to September 2022. Patients with acute BAO were classified into 3 groups according to stroke etiology (large-artery atherosclerosis [LAA], cardioembolism, and undetermined cause/other determined cause [UC/ODC]). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90-day mortality. RESULTS A total of 340 patients with BAO were included, 150 (44.1%) had LAA, 72 (21.2%) had cardioembolism, and 118 (34.7%) had UC/ODC. For patients treated with BMT plus EVT and BMT alone, respectively, the rate of favorable outcome at 90 days was 49.1% and 23.8% in the LAA group (odds ratio, 3.08 [95% CI, 1.38-6.89]); 52.2% and 30.8% in the cardioembolism group (odds ratio, 2.45 [95% CI, 0.89-6.77]); and 37.5% and 17.4% in the UC/ODC group (odds ratio, 2.85 [95% CI, 1.16-7.01]), with P=0.89 for the stroke etiology×treatment interaction. The rate of symptomatic intracranial hemorrhage in EVT-treated patients with LAA, cardioembolism, and UC/ODC was 8.3%, 2.2%, and 3.2%, respectively, and none of the BMT-treated patients. Lower 90-day mortality was observed in patients with EVT compared with BMT alone across 3 etiology groups. CONCLUSIONS Among patients with acute BAO, EVT compared with BMT alone might be associated with favorable outcomes and lower 90-day mortality, regardless of cardioembolism, LAA, or UC/ODC etiologies. The influence of stroke etiology on the benefit of EVT should be explored by further trials. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04751708.
Collapse
Affiliation(s)
- Guangxiong Yuan
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, MA (T.N.N.)
| | - Lei Liu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Rui Li
- Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.)
| | - Hong Xia
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Chen Long
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Junxiong Wu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Jun Xu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Feng Huang
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Bo He
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Derong Wu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Hailing Wang
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Can Feng
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Yong Liang
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Xianghong Zhou
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Zhenhua Xiao
- Department of Emergency, Shaoshan People's Hospital, China (Z.X.)
| | - Li Luo
- Department of Head and Neck Surgery, Xiangtan Central Hospital, China (L. Luo)
| | - Yanjuan Hu
- Department of Emergency, The First People's Hospital of Xiangtan, China (Y.H.)
| | - Bin Liu
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Weibo Peng
- Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), China (G.Y., L. Liu, H.X., C.L., J.W., J.X., F.H., B.H., D.W., H.W., C.F., Y.L., X.Z., B.L., W.P.)
| | - Chao Zhang
- Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.)
| | - Tao Cui
- Department of Neurology, Taihe Country People's Hospital, Linquan, China (T.C.)
| | - Gaoshan Zhao
- Department of Neurology, Linquan Country People's Hospital, China (G.Z.)
| | - Lihua Xu
- Department of Neurology, Jiamusi Central Hospital, China (L.X.)
| | - Gaoting Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (G.M.)
| | - Wei Hu
- Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, China (R.L., C.Z., W.H.)
| |
Collapse
|
2
|
Bucci T, Sagris D, Harrison SL, Underhill P, Pastori D, Ntaios G, McDowell G, Buckley BJR, Lip GYH. C-reactive protein levels are associated with early cardiac complications or death in patients with acute ischemic stroke: a propensity-matched analysis of a global federated health from the TriNetX network. Intern Emerg Med 2023; 18:1329-1336. [PMID: 37119383 PMCID: PMC10412660 DOI: 10.1007/s11739-023-03280-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/14/2023] [Indexed: 05/01/2023]
Abstract
The role of inflammation in predicting early cardiac complications among stroke patients is unclear. Electronic medical records from TriNetX, a global federated health research network, were used for this retrospective analysis. Patients with ischemic stroke and C-Reactive Protein (CRP) levels measured within 24 h post-stroke were categorized into three groups: (i) < 1 mg/L, (ii)1-3 mg/L and (iii) > 3 mg/L. The primary outcome was a composite outcome of cardiac complications (heart failure (HF), ischemic heart disease, atrial fibrillation (AF), ventricular arrhythmias and Takotsubo cardiomyopathy) or death at 30 days from the index event. Cox-regression analyses were used to produce hazard ratios (HRs) and 95% confidence intervals (CI) following 1:1 propensity score matching (PSM). Of the 104,741 patients enrolled, 51% were female and the mean age was 66 ± 16 years. After PSM, a new cardiac complication or death within 30 days occurred in 5624 (33.1%) patients with CRP > 3 mg/L, in 4243 (25.6%) patients with CRP 1-3 mg/L and in 3891 (23.5%) patients with CRP < 1 mg/L. Patients with CRP levels of 1-3 mg/L and > 3 mg/L had higher risk of the composite outcome (HR 1.10, 95%CI 1.05-1.52; HR 1.51, 95%CI 1.45-1.58), death (HR 1.43, 95%CI 1.24-1.64; HR 3.50, 95%CI 3.01-3.96), HF (HR 1.08, 95%CI 1.01-1.16; HR 1.51, 95%CI 1.41-1.61), AF (HR 1.10, 95% CI:1.02-1.18; HR 1.42, 95%CI 1.33-1.52) and ventricular arrhythmias (HR 1.25, 95%CI 1.02-1.52; HR 1.67, 95% CI 1.38-2.01) compared to those with CRP < 1 mg/L. Ischemic heart disease were more common among patients with CRP levels > 3 mg/L compared to those with CRP < 1 mg/L (HR:1.33, 95% CI:1.26-1.40), while no association with Takotsubo cardiomyopathy was found in all the analyses. CRP levels within the first 24 h of an ischemic stroke predict 30-day cardiac complications or death.
Collapse
Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Dimitrios Sagris
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK
| | | | - Daniele Pastori
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Garry McDowell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, William Henry Duncan Building 6 West Derby Street, Liverpool, L7 8TX, UK.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
3
|
Chen L, Wang M, Yang C, Wang Y, Hou B. The role of high-sensitivity C-reactive protein serum levels in the prognosis for patients with stroke: a meta-analysis. Front Neurol 2023; 14:1199814. [PMID: 37342777 PMCID: PMC10278886 DOI: 10.3389/fneur.2023.1199814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Background The impact of high-sensitivity C-reactive protein (hs-CRP) as a biomarker of inflammation on the prognosis of stroke patients remains controversial, this study was conducted to evaluate the prognostic value of hs-CRP levels for patients with stroke. Methods PubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to October 28, 2022. Outcome measures were all-cause mortality, recurrent stroke, and poor prognosis. The relationship between the highest versus lowest levels of hs-CRP or per unit increment and outcomes as measured by risk ratio (RR) and corresponding 95% confidence intervals (CI). Results A total of 39 articles were eligible for meta-analysis. High hs-CRP levels at admission were associated with mortality among patients with acute ischemic stroke (AIS) [RR = 3.84, 95% CI (2.41 ~ 6.111); p < 0.001], risk of recurrent stroke [RR = 1.88, 95%CI (1.41 ~ 2.52); p < 0.001], and poor prognosis [RR = 1.77, 95% CI (1.59 ~ 1.97); p < 0.001]. The risk ratios for the association of per unit increase in hs-CRP levels with mortality, risk of recurrent stroke, and poor prognosis were as follows, respectively: 1.42 [95% CI (1.19-1.69); p < 0.001], 1.03 [95% CI (1.01-1.04); p = 0.003], and 1.27 [95% CI (1.10-1.47); p = 0.001]. For hemorrhagic stroke (HS), the risk ratios (RR) for the highest versus the lowest (reference) category of hsCRP or per unit increment to all-cause mortality were 4.36 [95% CI (1.38-13.73); p = 0.012] and 1.03 [95% CI (0.98-1.08); p = 0.238]. Conclusion Hs-CRP levels are strongly associated with mortality, risk of stroke recurrence and poor prognosis in stroke patients. Therefore, hs-CRP levels may contribute to the prognosis prediction of these patients.
Collapse
Affiliation(s)
- Liuting Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Min Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Chanrui Yang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Yefei Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Bonan Hou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| |
Collapse
|
4
|
Yang M, Liang J, Weng B, Liang J, Lu T, Yang H. Total Cerebral Small Vessel Disease Burden Predicts the Outcome of Acute Stroke Patients after Intra-Arterial Thrombectomy. Cerebrovasc Dis 2023; 52:616-623. [PMID: 36913934 DOI: 10.1159/000528603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/30/2022] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Various types of cerebral small vessel diseases (cSVD) markers commonly coexist. The neurological function outcome is affected by their combined effect. To investigate the effect of cSVD on intra-arterial thrombectomy (IAT), our study aimed at developing and testing a model with fusing a combination of multiple cSVD markers as total cSVD burden to predict the outcome of acute ischemic stroke (AIS) patients after IAT treatment. METHODS From October 2018 to March 2021, continuous AIS patients with IAT treatment were enrolled. We calculated the cSVD markers identified by magnetic resonance imaging. The outcomes of all patients were assessed according to the modified Rankin Scale (mRS) score at 90 days after stroke. The relationship between total cSVD burden and outcomes was analyzed by logistics regression analysis. RESULTS A total of 271 AIS patients were included in this study. The proportions of score 0∼4 in the total cSVD burden group (i.e., score 0, 1, 2, 3, and 4 groups) were 9.6%, 19.9%, 23.6%, 32.8%, and 14.0%, respectively. The higher the cSVD score, the more patients with a poor outcome. Heavier total cSVD burden (1.6 [1.01∼2.27]), diabetes mellitus (1.27 [0.28∼2.23]), and higher national institute of health stroke scale (NIHSS) on admission (0.15 [0.07∼0.23]) were associated with poor outcome. In the two Least Absolute Shrinkage and Selection Operator regression models, model 1 using age, duration from onset to reperfusion, Alberta stroke program early CT score (ASPECTS), NIHSS on admission, modified thrombolysis in cerebral infarction (mTICI) and total cSVD burden as variables perform well on predicting short-term outcome in area under curve (AUC) of 0.90. Model 2, including all of the variables above except cSVD, showed less predictive capability than model 1 (AUC 0.90 vs. 0.82, p = 0.045). CONCLUSIONS The total cSVD burden score was independently associated with the clinical outcomes of AIS patients after IAT treatment and it may be a reliable predictor for poor outcomes of AIS patients after IAT treatment.
Collapse
Affiliation(s)
- Mengqi Yang
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jiahui Liang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer, Guangzhou, China
| | - Baohui Weng
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jinghong Liang
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Tao Lu
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Hong Yang
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| |
Collapse
|
5
|
Li H, Liu P, Ma HY, Hua WL, Zhang YX, Zhang L, Zhang YW, Hong B, Yang PF, Liu JM. Novel predictors and a predictive model of cerebrovascular atherosclerotic ischemic stroke based on clinical databases. Neurol Res 2022; 45:391-399. [PMID: 36413433 DOI: 10.1080/01616412.2022.2149185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Early identification of cerebrovascular atherosclerotic ischemic stroke is necessary for accurate treatment and clinical research. AIMS To identify novel predictors and build a predictive model of ischemic strokes due to cerebrovascular atherosclerosis. METHOD MIMIC-IV database was used to search for clinical data of patients with ischemic stroke. Included patients were divided into two groups according to their etiologies. Univariate and multivariate logistic regressions were used to build the predictive model, and the model reliability parameters were calculated. The cut-off value for the model was selected according to the Youden index. Clinical data from the Neurovascular Center of Changhai Hospital were used to verify the predictive model. RESULTS Logistical regressions showed a positive correlation between advanced age, peripheral atherosclerosis, history of transient ischemia, and the diagnosis of ischemic strokes due to cerebrovascular atherosclerosis. The history of atrial fibrillation, levels of the National Institutes of Health Stroke Scale, serum potassium, and activated partial thromboplastin time were negatively correlated to the diagnosis of cerebrovascular atherosclerotic ischemic stroke. The predictive model was constructed from logistic regression results, and the area under the curve was 0.764. The cut-off value for the model was set at 0.089 to achieve the highest Youden index, with sensitivity and specificity of 75.9% and 64.1%. Clinical verification of the model revealed that the sensitivity and specificity of the model were 52.5% and 93.0% respectively. CONCLUSION The efficacy of the predictive model was acceptable as an aid in predicting cerebrovascular atherosclerotic ischemic stroke.
Collapse
Affiliation(s)
- He Li
- Emergency Department, Naval Hospital of Eastern Theater, Zhoushan, China
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pei Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong-Yu Ma
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wei-Long Hua
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yong-Xin Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yong-Wei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Peng-Fei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian-Min Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
6
|
The negative affectivity dimension of Type D personality associated with increased risk for acute ischemic stroke and white matter hyperintensity. J Psychosom Res 2022; 160:110973. [PMID: 35749831 DOI: 10.1016/j.jpsychores.2022.110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study was conducted to examine the relationship among type D personality, acute ischemic stroke (AIS), and white matter hyperintensity (WMH). METHODS In a cross-sectional study conducted between September 2020 and June 2021, 235 patients aged 50-85 years with first-ever ischemic cerebrovascular disease, including 146 males and 89 females, were enrolled. All participants underwent the Type D Scale-14 test containing negative affectivity (NA) and social inhibition (SI) subscales. Clinical and laboratory data were also collected for analysis. The patients were divided into the AIS group (n = 148) and the transient ischemic attack (TIA) group (n = 87) according to whether there was an acute lesion. RESULTS Patients with type D personality had a higher frequency of AIS and LAA and a higher level of WMH. Multiple logistic regression showed that the NA score was related to a 1.11-fold increase in the odds of AIS (95% CI: 1.03-1.19). Neither NA nor SI showed a clear association with a higher frequency of LAA. Higher scores of NA (OR = 1.07, 95% CI: 1.01-1.15), SI (OR = 1.11, 95% CI: 1.03-1.19), and the interaction between the two dimensions (OR = 1.03, 95% CI: 1.01-1.05) were independently associated with an increased load of WMH. CONCLUSION Type D personality was related to AIS and WMH. In particular, it was NA, not SI, affected the occurrence of AIS. Our findings may provide new insights regarding behavioral vulnerability for the development of cerebrovascular disorders.
Collapse
|
7
|
Chen C, Qiao X, Guo J, Yang T, Wang M, Ma Y, Zhao S, Ding L, Liu H, Wang J. Related factors based on non-targeted metabolomics methods in minor ischaemic stroke. Front Endocrinol (Lausanne) 2022; 13:952918. [PMID: 36237188 PMCID: PMC9552842 DOI: 10.3389/fendo.2022.952918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to identify potential biomarkers associated with the occurrence of minor ischaemic stroke. METHODS Four hundred patients hospitalized with minor ischaemic stroke were enrolled in the department of neurological internal medicine in Taiyuan Central Hospital, and 210 healthy subjects examined at the Taiyuan Central Hospital Medical Center during the same period were selected. We collected information on the general demographic characteristics and fasting blood samples of the subjects. We then used untargeted metabolomic assay to measure blood glucose, blood lipids, homocysteine, and high-sensitivity C-reactive protein. RESULTS There were statistically significant differences between the mild ischemic stroke group and the healthy control group in smoking, hypertension, and physical activity (P< 0.05). Compared with the healthy group, the minor ischaemic stroke group showed increased lactate, pyruvate, trimetlylamine oxide levels, and lactic acid, pyruvic acid, and trimethylamine N-oxidation (TMAO) levels were statistically significant (P< 0.001). In the minor ischaemic stroke risk model, hypertension, physical activity, smoking, and elevated TMAO levels influenced the occurrence of minor stroke. CONCLUSION Increased levels of lactic acid, pyruvate, and TMAO may be related to the pathophysiological changes in the minor ischaemic stroke population. High blood pressure, a lack of physical activity, smoking, and increased TMAO level were the influencing factors for the occurrence of minor ischaemic stroke. The serum metabolite TMAO may be associated with MS occurrence.
Collapse
Affiliation(s)
- Chen Chen
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
- *Correspondence: Chen Chen, ; Jintao Wang,
| | - Xiaoyuan Qiao
- Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jianyong Guo
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Ting Yang
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Min Wang
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Yipeng Ma
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Shuhe Zhao
- Neurology Department, Taiyuan Central Hospital, Taiyuan, China
| | - Ling Ding
- Department of Epidemiology, Shanxi Medical University, Taiyuan, China
| | - Hong Liu
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jintao Wang
- Department of Epidemiology, Shanxi Medical University, Taiyuan, China
- *Correspondence: Chen Chen, ; Jintao Wang,
| |
Collapse
|
8
|
Guan Y, Yu C, Zuo W, Jia K, Liu F, Lu H, Wang X, Wang D, Wang X. Factors associated with prognosis after small-vessel occlusion among young and middle-aged patients: a hospital-based follow-up study. Postgrad Med 2021; 133:581-586. [PMID: 33866924 DOI: 10.1080/00325481.2021.1917250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Small-vessel occlusions are the most common causes of mild strokes and, in China, account for approximately 27.3% of ischemic stroke cases. However, the factors associated with short- and long-term outcomes appear contradictory. Thus, we assessed the factors related to outcomes 3 years after small-vessel occlusion among patients aged 18 to 55 years.Methods: Between 2007 and 2014, we recruited patients who experienced small-vessel occlusion (according to Trial of Org 10,172 in Acute Stroke Treatment [TOAST] classification) aged 18 to 55 years and conducted a hospital-based follow-up study. The assessed outcomes were mortality, recurrence, and dependency within 3 years after the initial stroke. The outcome determinants were assessed using a multivariate logistic regression analysis.Results: A total of 276 patients (men, 76.09%) with small-vessel occlusions were enrolled in this study. In addition, 85.1% of the patients had strokes between the ages of 45 and 55 years. The risk of recurrence within 3 years was higher for patients who had moderate strokes than for those who had mild events (relative risk [RR], 3.09; 95% confidence interval [CI], 1.14-8.34; P < 0.05). Further, the risk of dependency within 3 years was 2.61 times higher in obese patients than in non-obese patients (RR, 2.61; 95% CI, 1.00-6.79; P < 0.05). The risks of recurrence and dependency within 3 years increased by 17% and 18%, respectively, for each 1-unit increase in fasting plasma glucose levels (RR, 1.17; 95% CI, 1.05-1.30 and RR, 1.18; 95% CI, 1.06-1.32, respectively; both P < 0.05).Conclusion: Our findings suggest that small-vessel occlusions cause the heaviest disease burden in patients aged 45 to 55 years. To reduce stroke recurrence, young and middle-aged patients with small-vessel occlusions should control their fasting plasma glucose levels and manage their weight.
Collapse
Affiliation(s)
- Yalin Guan
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Changshen Yu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Wenchao Zuo
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Kun Jia
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Feng Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Hui Lu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Xiaodan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin China
| | - Xinping Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin China
| |
Collapse
|
9
|
Chen Z, He Y, Su Y, Sun Y, Zhang Y, Chen H. Association of inflammatory and platelet volume markers with clinical outcome in patients with anterior circulation ischaemic stroke after endovascular thrombectomy. Neurol Res 2021; 43:503-510. [PMID: 33402058 DOI: 10.1080/01616412.2020.1870359] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: To determine the correlation of inflammatory and platelet volume indices with the severity of stroke and 3-month clinical outcomes in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT).Methods: A retrospective analysis was conducted for AIS patients who underwent EVT at our hospital from 2015 to 2019. Inflammatory factors, including white blood count, neutrophil count, lymphocyte count, neutrophil to lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT) and interleukin-6 (IL-6), and platelet volume indices, including platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and MPV/PC levels were assessed. Results were analyzed between patients with favorable and unfavorable outcomes at 3 months post-EVT.Results: A total of 257 AIS patients were included in the study. There were 86 (33.5%) patients with favorable functional outcomes at 3 months. Compared to patients with favorable outcomes, those with poor outcomes have lower lymphocyte count, higher neutrophil count and NLR levels. There were no differences in hs-CRP,PCT and IL-6 between the two groups. The correlation analysis showed that the increase in MPV, PDW, and MPV/PC was related to the high level of the NIHSS score at admission. Multivariate logistic regression analysis showed that higher NLR levels are an independent risk factor for unfavorable outcomes at 3 months (OR = 1.141; 95% CI 1.061 to 1.227, P = 0.000).Conclusions: MPV, PDW, and MPV/PC are associated with stroke severity. Higher NLR levels upon admission may predict unfavorable functional outcomes in patients with AIS after undergoing EVT.Abbreviations ACA: anterior cerebral artery; AIS: acute ischemic stroke; ASPECTS: alberta stroke program early CT score; BMI: body mass index; DBP: diastolic blood pressure; END: early neurological deterioration; EVT: endovascular thrombectomy; hs-CRP: high-sensitivity C-reactive protein; HT: hemorrhagic transformation; ICA: internal carotid artery; IL-6: interleukin-6; IS: ischemic progression; LAA: Large-Artery Atherosclerosis; MCA: middle cerebral artery; MPV: mean platelet volume; mTICI: modified thrombolysis in cerebral infarction; NIHSS: National Institute of Health stroke scale; NLR: neutrophil to lymphocyte ratio; OTP: onset-to-puncture; PC: platelet count; PCT: procalcitonin; PDW: platelet distribution width; SBP: systolic blood pressure; sICH: symptomatic intracerebral hemorrhageWBC: white blood cell.
Collapse
Affiliation(s)
- Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanbo He
- Department of Neurology, The Beijing Moslem People Hospital, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yijia Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingbo Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, China
| | - Hongbo Chen
- Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| |
Collapse
|
10
|
Hu Z, Lai J, Chen L, Yi Y, Li R, Liao W. Can baseline C-reactive protein level predict functional outcome in acute ischaemic stroke? A meta-analysis. Biomarkers 2020; 25:525-532. [PMID: 32892646 DOI: 10.1080/1354750x.2020.1817982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between elevated C-reactive protein (CRP) level and poor functional outcome is conflicting in acute ischaemic stroke (AIS) patients. This meta-analysis sought to investigate the value of elevated CRP level in predicting poor functional outcome in AIS patients. MATERIAL AND METHODS A systematically literature search was performed in PubMed and Embase databases up to 31 October 2019. Prospective and retrospective studies evaluating the association between elevated CRP level and poor functional outcome (defined by the modified Rankin scale ≥3) beyond 3 months after AIS were included. RESULTS Ten studies with a total of 8087 AIS patients were identified in this meta-analysis. When compared with reference low CRP level, the highest CRP level was associated with an increased risk of poor functional outcome (multivariate-adjusted hazard ratio (HR) 1.99; 95% confidence interval (CI) 1.63-2.44) in a random effect model. Sensitivity analysis further confirmed the significance of CRP elevation for predicting poor functional outcome after AIS. CONCLUSIONS Elevated CRP level is significantly associated with poor functional outcome in patients with AIS. Baseline CRP level has potential to improve risk stratification of function outcome in AIS patients.
Collapse
Affiliation(s)
- Ziyi Hu
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Junyu Lai
- Department of Cardiology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lisha Chen
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Ying Yi
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Renliang Li
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Weimin Liao
- Department of Emergency, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| |
Collapse
|
11
|
Electroacupuncture Ameliorates Acute Myocardial Ischemia: A Potential Role of the Locus Coeruleus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4298657. [PMID: 32328129 PMCID: PMC7150682 DOI: 10.1155/2020/4298657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/20/2020] [Accepted: 03/06/2020] [Indexed: 01/08/2023]
Abstract
The locus coeruleus (LC) is closely linked with cardiovascular disease. However, whether it mediates the alleviating effect of electroacupuncture (EA) on acute myocardial ischemia (AMI) remains unclear. A rat model of myocardial ischemia was established through occlusion of the left anterior descending coronary artery. Multichannel in vivo recording and other techniques were used to assess neurons in the LC, norepinephrine (NE) and dopamine (DA) levels in central and myocardial tissue, serum levels of inflammatory factors, and cardiac function. After induction of AMI, LC neuron activity increased and the central NE concentrations increased, while those of DA decreased. Moreover, the serum levels of high-sensitivity C-reactive protein (hs-CRP) increased, whereas those of interleukin-10 (IL-10) decreased. However, these effects were reversed by EA. Additionally, LC lesioning affected NE and DA levels in myocardial tissue and weakened the antimyocardial ischemic effect of EA. Collectively, our results indicated that LC is closely related to AMI and plays an important role in the antimyocardial ischemic effect of EA. This mechanism may be related to inhibition of LC neuron activity by EA, which inhibits the release of large amounts of hs-CRP and promotes that of IL-10 in the serum. Besides, after LC lesioning, EA may improve cardiac function by inhibiting the release of large amounts of NE and promoting the release of DA in myocardial tissue.
Collapse
|
12
|
Wang L, Li Y, Wang C, Guo W, Liu M. C-reactive Protein, Infection, and Outcome After Acute Ischemic Stroke: A Registry and Systematic Review. Curr Neurovasc Res 2020; 16:405-415. [PMID: 31738143 DOI: 10.2174/1567202616666191026122011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
Background:
A number of studies have explored the prognostic role of CRP in patients
with acute ischemic stroke, however, the results have been inconclusive. The aim of our study was
to investigate the impact of infection on the association between CRP and 3-month functional outcome
by performing a registry study and systematic review.
Methods:
Patients admitted within 24 hours of acute ischemic stroke onset and had CRP measured
within 24 hours after admission were included. Patients admitted between June 2016 and December
2018 in Chengdu Stoke Registry were enrolled. The PubMed database was searched up to July
2019 to identify eligible studies. Poor outcome was defined as modified Rankin Scale scores at
3-month more than 3.
Results:
Totally, 368 patients in the registry and 18 studies involving 15238 patients in the systematic
review were included. A statistically significant association between CRP values on admission
and 3-month poor outcome in patients without infection was found, both in our registry
(CRP per 1-mg/L increment, OR 1.04, 95% CI 1.01 to 1.07, p=0.008) and meta-analysis (CRP per
1-mg/dL increment, OR 1.66 [95% CI 1.37 to 2.01, p<0.001]). In patients with infection, CRP was
not associated with a 3-month poor outcome according to registry data (OR 1.00, 95% CI 0.99 to
1.01, p=0.663) and meta-analysis (OR 1.01, 95% CI 0.99 to 1.01, p=0.128).
Conclusion:
High CRP value was independently associated with a 3-month poor outcome after
stroke in patients without infection. Further studies are required to examine the value of infection
on CRP measures and long-term functional outcomes.
Collapse
Affiliation(s)
- Lu Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuxiao Li
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Changyi Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wen Guo
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| |
Collapse
|
13
|
Gong P, Liu Y, Huang T, Chen W, Jiang T, Gong Y, Lu M, Wang M, Zhang Y, Zhang X, Deng Q, Zhou J. The association between high-sensitivity C-reactive protein at admission and progressive motor deficits in patients with penetrating artery infarctions. BMC Neurol 2019; 19:346. [PMID: 31884970 PMCID: PMC6935496 DOI: 10.1186/s12883-019-1538-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A fraction of patients with penetrating artery infarction (PAI) experience progressive motor deficit deterioration (PMD). We sought to investigate the role of high-sensitivity C-reactive protein (hs-CRP) at admission in predicting PMD. METHODS From January 2015 to September 2018, consecutive patients with PAI from three centers were prospectively enrolled in this study. PMD was defined as worsening of motor function score by ≥1 point on the National Institutes of Health Stroke Scale during the first 5 days after admission. Multivariable logistic regression analyses were performed to explore the relationship between hs-CRP and PMD in patients with PAI. We also performed receiver operating characteristic curve analysis and constructed a nomogram to assess the overall discriminative ability of hs-CRP in predicting PMD. RESULTS We ultimately included 544 patients (mean age, 65.4 ± 11.8 years). A total of 85 (15.6%) patients were identified to have PMD. Multivariate logistic regression analysis showed that hs-CRP was independently associated with PMD (P = 0.001). The optimal cutoff value for hs-CRP as a predictor for PMD was 3.48 mg/L, with a sensitivity of 73.64% and a specificity of 82.35% (area under curve, 0.792). Moreover, the nomogram we constructed indicated that higher level of hs-CRP was an indicator of PMD (c-index = 0.780, P < 0.001). CONCLUSIONS Our study suggested that hs-CRP might be a useful biomarker for predicting the risk of PMD in patients with PAI.
Collapse
Affiliation(s)
- Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Ting Huang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Wenxiu Chen
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yachi Gong
- Department of Gerontology, Nantong Third Peoples Hospital, Nantong University, 60 Mid-Youth Road, Nantong, 226006, Jiangsu, China
| | - Min Lu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China.
| | - Xiaohao Zhang
- Department of Neurology, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China.
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, China.
| |
Collapse
|
14
|
Lin F, Chen Y, Wan M, Chen W, Jia W. High-sensitivity C-reactive protein as an indicator of ischemic stroke in patients with isolated acute vestibular syndrome: Retrospective observational study. Medicine (Baltimore) 2019; 98:e18097. [PMID: 31770230 PMCID: PMC6890292 DOI: 10.1097/md.0000000000018097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ischemic strokes presenting with isolated acute vestibular syndrome (AVS) are not rare and still are challenging for diagnosis. In this retrospective study, we aimed to investigate the association of high-sensitivity C-reactive protein (hs-CRP) with stroke in patients with isolated AVS. A total of 217 patients with isolated AVS within 3 days of symptom onset were included. Serum hs-CRP levels were assessed within 24 hours of admission. The relationship between hs-CRP levels and stroke in patients with AVS were analyzed using univariate and multivariate models. The results showed that hs-CRP levels were significantly higher in infarction patients than that in noninfarction group. The stroke occurrence was increased with increasing quartile levels of hs-CRP. The highest quartile level of hs-CRP was associated with a higher occurrence of stroke compared with the lowest quartile group (adjusted odds ratio [OR], 4.099; 95% confidence interval [CI], 1.272-13.216; P = .018). We also found that male gender (adjusted OR, 5.635; 95% CI, 2.212-14.352; P < .001) and increased low-density lipoprotein cholesterol (LDL-C) (adjusted OR, 2.543; 95% CI, 1.175-5.505; P = .018) were independently associated with stroke in patients with AVS. In addition, using the receiver operating characteristic curve analysis, our study yielded a threshold value of hs-CRP at 1.82 mg/L, and demonstrated that combining hs-CRP with LDL-C improved the discriminatory ability to identify stroke patients with AVS (area under the curve of the combined model: 0.753; 95% CI = 0.684-0.821; P < .001). Hs-CRP may be a useful indicator of stroke in patients with AVS. More attention should be paid to the patients with elevated hs-CRP level.
Collapse
|
15
|
Chen CY, Wu RW, Tsai NW, Lee MS, Lin WC, Hsu MC, Huang CC, Lai YR, Kung CT, Wang HC, Su YJ, Su CM, Hsiao SY, Cheng BC, Chiang YF, Lu CH. Increased circulating endothelial progenitor cells and improved short-term outcomes in acute non-cardioembolic stroke after hyperbaric oxygen therapy. J Transl Med 2018; 16:255. [PMID: 30208940 PMCID: PMC6134692 DOI: 10.1186/s12967-018-1629-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background Acute ischemic stroke is a leading cause of mortality and long-term disability, and profiles of endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. This study tested the hypothesis that hyperbaric oxygen therapy (HBOT) both improves the clinical short-term outcomes and increases the number of circulating EPCs and antioxidant capacity. Methods The numbers of circulating EPCs [CD133+/CD34+ (%), KDR+/CD34+ (%)], biomarkers for oxidative stress (thiols and thiobarbituric acid-reactive substances), and clinical scores (National Institutes of Health Stroke Scale [NIHSS], Barthel index [BI], and modified Rankin Scale [MRS]) were prospectively evaluated in 25 patients with acute non-cardioembolic stroke under HBOT at two time points (pre- and post-HBOT). The biomarkers and clinical scores were compared with those of 25 age- and sex-matched disease controls. Results The numbers of KDR+/CD34+ (%) in the HBOT group following HBOT increased significantly, whereas the numbers of CD133+/CD34+ (%) also showed a tendency to increase without statistical significance. The mean high-sensitivity C-reactive protein levels showed significant decrease post-HBOT follow-up in the HBOT group. The changes in KDR+/CD34+EPC (%) numbers were positively correlated with changes in clinical outcomes scores (BI, NIHSS, and MRS) in the HBOT group. Conclusions Based on the results of our study, HBOT can both improve short-term clinical outcomes and increase the number of circulating EPCs in patients with acute non-cardioembolic stroke.
Collapse
Affiliation(s)
- Chen-Yu Chen
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Re-Wen Wu
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jih Su
- Department of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yuan Hsiao
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yi-Fang Chiang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. .,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
| |
Collapse
|
16
|
Zhu H, Li Z, Lv J, Zhao R. Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis. Neurol Res 2018. [PMID: 29543130 DOI: 10.1080/01616412.2018.1446283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Hui Zhu
- Medical College, Qingdao University, Qingdao, China
| | - Zhixing Li
- Medical College, Qingdao University, Qingdao, China
| | - Jinglei Lv
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Renliang Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|